In early 2019, I read a short book titled The Evolution of Medicine that forever changed the way I thought about chronic disease. One short sentence encapsulates much of what resonated:
It is clear that as we start to understand chronic disease as a journey, not as an event, there are obvious markers that tell us patients are moving along that path before they hit the required standard for differential diagnoses.
The Evolution of Medicine
At the time, I co-owned a CrossFit gym. I truncated the takeaway to, “No one gets heart disease or diabetes overnight.” It was a rallying cry for preventative care. If you get bloodwork and various tests done earlier, you can identify worrisome trends before they become significant problems.
In the first section of Outlive, Attia defines this idea as a shift from Medicine 2.0 to 3.0. The former was all about treating and prolonging life once you have a diseases (“reactive medicine”). The latter is about preventing you from getting a disease in the first place. He also delineates between increasing lifespan (how long you life) and healthspan (maintaining function for as long as possible).
Health insurance companies won’t pay a doctor very much to tell a patient to change the way he eats, or to monitor his blood glucose levels in order to prevent him from developing type 2 diabetes. Yet insurance will pay for this same patient’s (very expensive) insulin after he has been diagnosed.
Dr. Peter Attia, Outlive
Attia put definitions to the concepts I’ve been thinking about for several years. Better, earlier detection and focus can delay and prevent (expensive) catastrophes down the road.
In subsequent sections, he goes on to write about the four horsemen—the greatest killers of our time.
- Cardiovascular disease
- Metabolic dysfunction (diabetes, insulin resistance, etc.)
- Cancer
- Neurodegenerative disease (Alzheimer’s)
He breaks down each horseman explaining why they occur, guidelines for identifying worrisome trends, and preventative measures.
I walked away with a series of action steps including a number of blood tests to ask for at my next annual checkup. I also have a better understanding of each horseman. For example, Attia described the process of atherosclerosis in detail and provided color as to why HDL is often considered “good” cholesterol and LDL “bad.” While LDL is a measure correlated with cardiovascular disease, apoB (apolipoprotein B) and Lp(a) (pronounced “el-pee-little-A”) tend to be more direct indicators. He also described some advances in Alzheimer research including testing for the APOE genotype (a one-time test), which can indicate a higher risk for developing the disease.
In the final third of the book, Attia goes deep on lifestyle improvements (fitness, nutrition, sleep, and relationships) to improve your health. Since I spend a non-trivial amount of time reading about these areas generally, I pulled less from this section, but it was a helpful reminder nonetheless. Some specifics: Emphasize weight training, sleep 7+ hours per night, get plenty of low-intensity cardio, and surround yourself with positive relationships. His approach to nutrition was also unique in that it didn’t prescribe a specific diet. Rather, the general takeaway was to consume an appropriate number of calories. This is possible through restriction diets (vegetarianism, keto, paleo, etc.), time restricted feeding (fasting), or traditional dieting.
Summary
Outlive is a fantastic read and provides a lexicon for many of the concepts I’ve been thinking about. In Medicine 3.0—geared towards increasing healthspan and preventing, not just treating, chronic disease—is a future I believe in wholeheartedly. I think of a world where Type 2 diabetes (completely preventable and reversible) doesn’t impact ~10+% of the adult population (with disastrous consequences for them personally and our society as a whole). Medicine 3.0 describes an approach to get there with earlier, more precise testing and lifestyle interventions. The trick is figuring out how to make these advancements more accessible for everyone—an area I’m keen to explore.